2021年经济学人 我是男还是女,这是个问题(1)（在线收听）

Gender medicine

性别医学

Second thoughts

三思

Doubts are growing about therapy for gender-dysphoric children

对于性别焦虑症儿童的治疗方法，人们的质疑越来越多

Gender medicine was once an obscure specialty. Patients with gender dysphoria were typically middle-aged men wishing to live as women. Things are different now. First, there are many more patients. Referrals to a specialist clinic attached to the Free University of Amsterdam rose 20- fold between 1980 and 2015. The Gender Identity Development Service (GIDS), England and Wales's only paediatric gender clinic, sees 30 times more people than a decade ago. The patients have changed, too. Most are now female and in their teens. Many are treated with drugs to block the onset of puberty. These are often followed by hormones to promote development of physical characteristics of the opposite sex, as part of an approach called affirmation therapy.

性别医学曾经是一个不起眼的专业。性别焦虑症患者通常是希望像女性一样生活的中年男性。现在情况不同了。首先，病人更多了。从1980年到2015年，到阿姆斯特丹自由大学的一家附属专家诊所就诊的人数增加了20倍。性别认同发展服务(GIDS)是英格兰和威尔士唯一的一家儿科性别诊所，就诊人数是10年前的30倍。患者也发生了变化，现在大多数都是十几岁的女性。许多人用药物来阻止青春期的开始，通常伴随着用荷尔蒙来促进异性身体特征的发展，是“肯定疗法”的一种。

Last June, though, Finland revised its guidelines to prefer psychological treatment to drugs. In September Britain launched a top-down review of the field. In December the High Court of England and Wales ruled that under-16s were unlikely to be able to consent meaningfully to taking puberty blockers, leading GIDS to suspend new referrals, though a subsequent ruling held that parents could consent on their children's behalf. On April 6th Arkansas passed laws that make prescribing puberty blockers and cross-sex hormones to children illegal. Also in April the Astrid Lindgren Children's Hospital in Stockholm, a part of the Karolinska Institute, announced that it would stop prescribing puberty blockers and cross-sex hormones to those under 18, except in clinical trials.

然而，去年6月，芬兰修订了其指导方针，将心理治疗置于药物之上。9月，英国对该领域展开了一项自上而下的审查。去年12月，英格兰和威尔士高等法院裁定，16岁以下的青少年不太可能有意义地同意服用青春期阻滞药，这导致GIDS暂停了新的转诊，尽管随后的裁决认为父母可以代表孩子同意。4月6日，阿肯色州通过了一项法律，规定给儿童开青春期阻断剂和跨性别激素是非法的。同样在4月，斯德哥尔摩的阿斯特里德·林德格伦儿童医院(隶属于卡罗林斯卡研究所)宣布，除临床试验外，将停止给18岁以下儿童开青春期阻断剂和跨性别激素的处方。

Those sceptical of affirmation therapy point out two problems. Evidence is lacking, and what exists is not reassuring. A reviewby Sweden's health authorities in2019 found little research, mostly of poor quality. Britain's National Institute for Health and Care Excellence found that puberty blockers did little to dispel gender dysphoria or improve patients' mental health (though they do not make such feelings worse). Moreover, existing studies suggest that, without intervention, most children with gender dysphoria end up reconciled to their natal sex as adults.

那些对“肯定疗法”持怀疑态度的人指出了两个问题。缺乏证据，现有的证据也不可靠。瑞典卫生当局2019年的一项评估发现，针对这方面的研究极少，而且研究质量差。英国国家健康和卓越保健研究所发现，青春期阻断剂对消除性别焦虑或改善患者的心理健康没有什么作用(尽管不会让患者感觉更焦虑)。此外，现有的研究表明，如果不进行干预，大多数患有性别焦虑症的儿童最终会在成年后接受他们的出生性别。